Блокатор "медленных" кальциевых каналов. Лерканидипин является рацемической смесью право- (R) и левовращающихся (S) стереоизомеров, производное 1,4-дигидропиридина, способен избирательно блокировать ток ионов кальция внутрь клеток сосудистой стенки, сердечные клетки и клетки гладкой мускулатуры. Механизм антигипертензивного действия обусловлен прямым релаксирующим действием на гладкомышечные клетки сосудов. Обладает пролонгированным антигипертензивным действием. Терапевтический эффект достигается через 5-7 ч после приема внутрь и длительность его сохраняется в течение суток (24 ч). Благодаря высокой селективности к гладкомышечным клеткам сосудов отрицательное инотропное действие отсутствует. Занидип-Рекордати является метаболически нейтральным препаратом и не оказывает существенного воздействия на содержание липопротеинов и аполипопротеинов в сыворотке крови, а также не изменяет липидный профиль у пациентов с артериальной гипертензией.
Показания к применению
— эссенциальная гипертензия мягкой и умеренной степени тяжести.
Противопоказания
Хроническая сердечная недостаточность в стадии декомпенсации
Нестабильная стенокардия
Обструкция сосудов, исходящих из левого желудочка сердца
Недавно перенесенный инфаркт миокарда (в течение 1 месяца)
Тяжелые нарушения функции печени
Нарушения функции почек (скорость клубочковой фильтрации менее 39 мл/мин)
Одновременное применение с мощными ингибиторами изофермента CYP3A4 (кетоконазол, итраконазол, эритромицин), а также с грейпфрутовым соком, циклоспорином
Детский и подростковый возраст до 18 лет (эффективность и безопасность не установлены)
Беременность
Период лактации
Женщины детородного возраста, не пользующиеся надежными средствами контрацепции
Повышенная чувствительность к лерканидипину, другим производным дигидропиридинового ряда или любому компоненту препарата. С осторожностью: нарушения функции печени легкой и средней степени тяжести; синдром слабости синусового узла (без кардиостимулятора); левожелудочковая недостаточность и ИБС; хроническая сердечная недостаточность; одновременный прием бета-адреноблокаторов, дигоксина
Применение при беременности и в период грудного вскармливания
Препарат противопоказан к применению при беременности и в период лактации.
Способ применения и дозы
Препарат назначают по 10 мг 1 раз/сут (утром) не менее чем за 15 мин до еды. В зависимости от индивидуального эффекта доза препарата может быть увеличена до 20 мг. Терапевтическая доза подбирается постепенно, при необходимости увеличение дозы осуществляется через 2 недели после начала приема препарата. Таблетки принимают внутрь, не разжевывая, запивая достаточным количеством воды. У пожилых пациентов коррекции дозы не требуется, однако, при приеме препарата необходим постоянный контроль состояния пациентов. При наличии почечной или печеночной недостаточности легкой или средней тяжести, как правило, коррекции дозы не требуется; начальная доза – 10 мг, затем следует с осторожностью увеличивать дозу до 20 мг/сут. В случае, если антигипертензивный эффект будет слишком сильно выражен, следует снизить дозу.
Побочное действие
Частота возникновения нежелательных явлений классифицировалась следующим образом: очень часто (1/10), часто (1/100), нечасто (1/1000), редко (1/10 000), очень редко (<1/10 000). Со стороны нервной системы: редко - сонливость; нечасто - головная боль, головокружение. Со стороны иммунной системы: очень редко - повышенная чувствительность. Со стороны сердечно-сосудистой системы: нечасто - тахикардия, ощущение сердцебиения, приливы крови к коже лица; редко - стенокардия; очень редко - обморок, выраженное снижение АД, боли в груди, инфаркт миокарда. Со стороны пищеварительной системы: редко - тошнота, рвота, диарея, боли в животе, диспепсия; очень редко - обратимое повышение активности печеночных ферментов. Со стороны кожи: редко - кожная сыпь. Со стороны костно-мышечной системы: редко - миалгия. Со стороны мочевыделительной системы: редко - полиурия. Прочие: нечасто - периферические отеки; редко - астения, повышенная утомляемость; очень редко - гиперплазия десен.
Передозировка
Симптомы: периферическая вазодилатация с выраженным снижением АД и рефлекторной тахикардией, увеличение частоты и продолжительности приступов стенокардии, инфаркт миокарда. Лечение: проводят симптоматическую терапию.
Особые указания
Следует соблюдать осторожность при назначении пациентам с нарушением функции почек, ИБС (существует риск учащения приступов стенокардии). Перед началом применения препарата необходимо компенсировать хроническую сердечную недостаточность. Особую осторожность следует соблюдать на начальных стадиях лечения пациентов с легкой и средней степенью выраженности недостаточности функции печени. Влияние на способность к вождению автотранспорта и управлению механизмами В период лечения необходимо соблюдать осторожность при выполнении работ, требующих повышенного внимания, при управлении транспортными средствами, особенно в начале лечения и при повышении дозы препарата (риск развития сонливости, головной боли и головокружения).
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